White House pledges executive action on Medicaid in the coming weeks, Rep. Chip Roy says

Rep. Chip Roy said Thursday he felt comfortable voting for President Trump's "Big, Beautiful Bill," in part, because the White House promised executive orders to address some of the lawmaker's concerns about Medicaid spending.

Speaking on CNBC shortly after the House passed the bill, the Texas Republican recounted a breakthrough meeting with Mr. Trump and House Freedom Caucus members like himself who were pushing for changes to the bill to further reduce federal spending on Medicaid for able-bodied adults.

The hard-line conservatives were unable to secure many changes in the bill, but promises of executive orders helped supplement the tweaks they did get.

"We got pretty firm commitments yesterday from the White House in the form of legislative language to help the non-expansion states under Obamacare get some additional support to try to prevent the pressure on Texas and Tennessee and Florida to expand," he said.

Medicaid was created in 1965 under President Lyndon B. Johnson to provide health insurance for low-income people, but it was limited to mothers and children, pregnant women and people with disabilities.

The program expanded under Obamacare to include low-income, able-bodied adults without dependents earning up to 138% of the poverty level. The law directed every state to expand the program, but the Supreme Court in 2012 ruled it optional. Currently, 40 states and the District of Columbia have adopted the expansions.

Last-minute changes to the bill included the language Mr. Roy referenced, an increase in the cap on state-directed payments — supplemental payments to Medicaid providers for services delivered through managed care — for non-expansion states to 110% of the Medicare rate for a given health care service, compared to a 100% cap for expansion states.

"We also got some commitments out of the White House to make some other changes that they might be taking some actions on at the executive level that we'll see, I think, in the coming weeks," Mr. Roy said.

He did not elaborate on what those executive orders would entail.

White House Office and Management Budget Director confirmed to reporters Thursday that the administration was eying executive actions to address the Freedom Caucus' concerns.

"We're going to do everything we can executively to make sure that one of their main concerns was that, with this opportunity to do something big on Medicaid, that more States did not come in and expand Medicaid under Obamacare," he said.

Mr. Roy said he would have liked to secure other changes to Medicaid in the bill, like lowering the 90% federal share of costs for states that expanded the program to able-bodied adults to better match the rates the government pays states to cover the most vulnerable.

He also wanted further changes to Medicaid provider taxes to eliminate what he calls a "money laundering scheme."

States use taxes on hospitals and other health-care providers to finance their share of Medicaid. But some states use the tax revenue to increase Medicaid payments to the same providers, which then inflates the total cost of their Medicaid programs and the share the federal government must contribute.

Mr. Roy has not given up hope that those issues will be addressed in the final bill, based on his conversations with like-minded colleagues in the Senate.

"The Senate is very interested in dealing with these issues, so we'll keep working on it," he said.

Another issue that Mr. Roy and fellow Freedom Caucus members prioritized was ending clean energy tax credits, which they call the "green new scam."

He said they did not get as much as they wanted but were pleased to secure provisions for stringent requirements on construction for clean energy projects to qualify for tax credits.

"Within 60 days of enactment, if you're not constructing, you're not going to get subsidies," he said.